What do I need to do to prepare for surgery?

Once you have decided on a surgical date and confirmed it, we require each patient to have a history and physical within 30 days of surgery.  Depending on the procedures and patient’s health, some basic lab work such as a CBC may be requested. Patients over age 50 require an EKG. This can either be done with your local physician or primary care physician that we can recommend in Los Angeles or San Francisco Bay.

Are there any medications I should STOP taking prior to surgery?

Yes, any medication can cause potential bleeding issues.  You should STOP all aspirin, ibuprofen (Advil, Motrin, Naprosyn,  vitamin E and Gingko Biloba products seven days prior to surgery.  Those medications increase the risk of bleeding.  You should quit smoking AS SOON AS POSSIBLE and at least 4 weeks before and 4 weeks after surgery.  Any type of smoking can cause issues with wound healing.  ALL hormones with estrogen including birth control pills should be stopped 1 week prior to surgery unless your primary care physician or endocrinologist feels otherwise.   Patients typically resume their hormones about 1 to 2 days following surgery—as soon as they are up and walking around frequently.  Estrogen containing hormones can increase the risks of developing blood clots.

How soon prior to surgery should I arrive in Los Angeles or San Francisco Bay?

You should plan on arriving in Los Angeles or San Francisco Bay at least 2-3 days prior to surgery to give yourself plenty of time for the presurgery visit with Dr. Keojampa. The presurgery visit is typically 1 or 2 days before your surgery.  This also gives you time to fill any necessary postoperative medications for pain and antibiotics at the local pharmacy.  If needed, 3D CT Facial scans are performed for surgical planning.

How long should I stay in Los Angeles or San Francisco Bay?

Patients typically stay about one week after surgery. Dr. Keojampa removes sutures 7-8 days after surgery. After sutures are removed, you can safely travel back home.

SURGERY RISKS & INFORMED CONSENT

Any type of surgery carries risk.  Aesthetic craniofacial surgery is highly invasive with the potential for severe complications but when performed by an experienced surgeon, major complications are EXTREMELY rare.  Complication rates have a direct correlation with surgeon experience along with how often they perform a specific surgery.  Aesthetic craniofacial surgery and facial feminization surgery are not commonly performed with very few experts in the world.  It is important to ask your surgeon how often they perform the specific surgeries you are seeking.   Risks include injury to the brain, eye, major bleeding, numbness to the forehead and jaw, injury to the nerves that move the face and sensory nerves to the face, infection, and possibly death.

Experienced qualified surgeons should be able to show you a large portfolio of before and afters during the consultation.  We only allow viewing before and after photos during the consultation to protect the privacy of our patients.   As one of the few experts in Facial Feminization Surgery, Dr. Keojampa is able to provide a unique perspective in understanding feminine and masculine characteristics. His extensive training and experience ensure the safest surgery even with the most complex craniomaxillofacial, plastic, and cosmetic procedures with superior results.   Dr. Keojampa is one of the busiest facial feminization and craniomaxillofacial surgeons in the world, performing on average of three full feminization surgeries weekly along with rhinoplasty, sliding genioplasty, facelifts, and aesthetic orthognathic surgery/double jaw surgery.

POST-OPERATIVE INSTRUCTIONS

Typically, if you are having limited facial feminization surgeries such as forehead contouring only, most patients are able to comfortably return back to their hotel the same day after a recovery period at our ambulatory surgery center.  For more extensive procedures with combined forehead, cheek, jaw contouring, or surgeries lasting more than 6 hours, we require at least 1 night stay at either the hospital or an after care facility.

Immediately following the surgery you will wake up in the recovery room and will be quite groggy, this is very normal. If you are leaving following your surgery then you will be brought to the short-stay recovery room to relax until you are feeling well enough to leave with your escort.

Once you have returned to your hotel or nearby home, we encourage you to rest and relax as much as possible. Bruising or swelling will peak 3 days after surgery and icing the surgical areas as much as possible following surgery will help reduce swelling.  Swelling is a normal part of the healing process and can be managed with ice packs. Apply ice packs to the affected area for 20 minutes at a time, with 20 minutes of rest in between, for the first 48-72 hours.  Pain medication is prescribed to keep you as comfortable as possible. Most patients use their pain medication for 4- 6 days after surgery and then switch to Extra-Strength Tylenol. Once a day, incisions should be cleaned with water and a tiny amount of hydrogen peroxide. An antibacterial ointment is then put on the incisions, covered with gauze and the head is rewrapped with the ace bandage.  If you had any forehead cranioplasty or nasal procedures, please DO NOT blow your nose for at least 4 weeks after surgery.  DO NOT push on your forehead or jaw.  You may use nasal saline rinses to  moisturize and clean your nose.

Following surgery, a soft dressing is placed around the forehead and left in position overnight. Your first postoperative visit with Dr. Keojampa will be 1 day after surgery. The dressing is then replaced with an ace bandage for 7-10 days after surgery. The bandage reduces swelling and helps protect the area. Patients do experience extensive bruising and swelling immediately following the surgery. This swelling improves quickly over the first few days. Showering and gentle washing of the hair are permissible but must be done with care. It is important to towel dry and comb your hair towards the incision line (so as not to stretch it or pull at it) and to only use a blow-dryer on the “cool” setting (unheated).

Sutures are removed 6-8 days after surgery at a second post-operative visit with Dr. Keojampa. Most patients feel well enough to return to work 8-9 days after surgery; however, if the surgery is combined with multiple procedures then it may be advisable to wait two weeks before returning to work. Strenuous activity (causing sweating or rise in blood pressure) and light exercise should be avoided for at least two weeks.

Infection after surgery is extremely rare; however, antibiotics are used during surgery to avoid any potential problems. Swelling and bruising on the forehead and around the eyes is common. The majority of this swelling and bruising will last under two weeks; however, it is normal to having some minor swelling even after several months. After one week cover-up makeup is allowed to mask any residual bruising. Sensitivity loss at the top of the head is common for several weeks after surgery and returns completely in most within 3 months although some patients have waited a bit longer – about 8-10 months.

RECOVERY AFTER SURGERY

Most patients will either spend 1 night in the hospital or an acute aftercare facility with 24hr nursing care and monitoring.   By default, we offer 24 hrs of postop care with a nurse we provide if surgery is greater than 6 hrs or involves the upper and lower face.  This is adequate for greater than 95% of patients.  If you anticipate more aftercare, we would recommend you contact our below listed aftercare options at your additional cost to extend past the first 24 hrs to your entire stay in California.   

During the first week after surgery, you should expect to take strong pain medications we prescribed for at least the first 5 days.  It is important to take pain medications EVERY 4 hrs in the first 5 days regardless if you feel pain or not.  Oral pain medications take 30 minutes to take effect.  If you are already having pain, then it will be a long uncomfortable 30 minutes before it takes effect.  Following this regimen cannot be overstated. 

Keep your head elevated at all times. When sleeping, use two pillows to prop up your head and support your neck. It is not necessary to sleep at a 90° angle but keeping your head above your heart is best. Do not sleep on your side for one week and if necessary, place pillows on the side your face to prohibit yourself from turning your face while sleeping.  Swelling is a normal part of the healing process and can be managed with ice packs. Apply ice packs to the affected area for 20 minutes at a time, with 20 minutes of rest in between, for the first 48-72 hours

Bacitracin antibiotic ointment should be placed once daily along any incisions.  Any procedures involving oral incisions will require twice daily peridex antibiotic mouth rinses.  Specific instructions will accompany the prescription medications dispensed.

Short walks following surgery are encouraged but please have an escort with you the first couple of trips. Soft foods like fruit shakes, yogurt, soup and scrambled eggs are good choices following surgery since they are easy to prepare and eat.

You may shower 24 hours following surgery, however, avoid prolonged baths. Your incisions can get wet but avoid soaking them for long periods of time.  Do not bend over to wash your hair, instead, hold your head back in the shower. Be gentle with your face and scalp—especially when toweling dry and do not massage the scalp. Do not blow your nose for at least 4 weeks after surgery.  Do not use hot hair rollers for two weeks and do not get your hair cut or colored for six weeks.  You can resume a normal diet for  most surgeries involving the forehead and jaw with the exception of orthognathic or double jaw surgery.  Separate instructions will be given to you if you are having orthognathic or double jaw surgery.

Swelling and recovery vary depending on procedures.  In general, rhinoplasty and jaw surgery take the longest to see the final result.  Swelling tends to persist and the final results are not seen until 12-18 months.  Swelling timelines for both Rhinoplasty and Jaw Surgery are as follows:  50% of swelling resolved at 1 month, 70% at 3 months, and the last 30% of swelling will take 12-18 months to completely resolve.  Asymmetric swelling is very common in the early postsurgical period and patience will be required.

NURSING AFTER CARE OPTIONS

We can help arrange additional aftercare options based on your needs.   Please notify our patient concierge if desired.  These options need to be arranged several weeks prior to your surgery date.   While we provide 24 hrs of nursing care after surgery, it is your responsibility to determine if you desire additional aftercare beyond. 

Los Angeles

Care & Recover – Private Post Surgery Care & Concierge Services

AURA AFTERCARE FOR POST SURGICAL RECOVERY

San Francisco Bay Area

Surgical Aftercare By Kat Toussaint

Solos Concierge Nurse Patient Advocates – www.solosnurse.com

Giti with Bay Area Post Operative Care – www.bayareapostoperativecare.com